Journal Article

Structural brain changes are associated with response of negative symptoms to prefrontal repetitive transcranial magnetic stimulation in patients with schizophrenia

Frank, E, Ohmann, C, Koutsouleris, N, Langguth, B, Verde, P E, Dwyer, D, Cordes, J, Hasan, A, Eichhammer, P, Musso, F, Wölwer, W, Wobrock, T, Honer, W G, Cabral, C, Rietschel, M, Landgrebe, M, Falkai, P, Schneider-Axmann, T, Hajak, G, Winterer, G, Poeppl, T B, Guse, B, Ahmed, R, Castro, M F U, Dechent, P, Kreuzer, P M, Gaebel, W, Malchow, B

2017

Overview

Impaired neural plasticity may be a core pathophysiological process underlying the symptomatology of schizophrenia. Plasticity-enhancing interventions, including repetitive transcranial magnetic stimulation (rTMS), may improve difficult-to-treat symptoms; however, efficacy in large clinical trials appears limited. The high variability of rTMS-related treatment response may be related to a comparably large variation in the ability to generate plastic neural changes. The aim of the present study was to determine whether negative symptom improvement in schizophrenia patients receiving rTMS to the left dorsolateral prefrontal cortex (DLPFC) was related to rTMS-related brain volume changes. A total of 73 schizophrenia patients with predominant negative symptoms were randomized to an active ( n= 34) or sham ( n= 39) 10-Hz rTMS intervention applied 5 days per week for 3 weeks to the left DLPFC. Local brain volume changes measured by deformation-based morphometry were correlated with changes in negative symptom severity using a repeated-measures analysis of covariance design. Volume gains in the left hippocampal, parahippocampal and precuneal cortices predicted negative symptom improvement in the active rTMS group (all r ⩽−0.441, all P ⩽0.009), but not the sham rTMS group (all r ⩽0.211, all P ⩾0.198). Further analyses comparing negative symptom responders (⩾20% improvement) and non-responders supported the primary analysis, again only in the active rTMS group ( F (9, 207) =2.72, P= 0.005, partial η 2 =0.106). Heterogeneity in clinical response of negative symptoms in schizophrenia to prefrontal high-frequency rTMS may be related to variability in capacity for structural plasticity, particularly in the left hippocampal region and the precuneus.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 59/57 / 692/699/476/1799 / Adult / Behavioral Sciences / Biological Psychology / Brain - physiopathology / Brain research / Care and treatment / Clinical trials / Cortex (parietal) / Double-Blind Method / Emotional behavior / Epidemiology / Female / Hippocampal plasticity / Hippocampus / Humans / Intervention / Magnetic brain stimulation / Magnetic fields / Male / Medicine / Medicine & Public Health / Mental disorders / Mental health / Morphometry / Neuronal Plasticity - physiology / Neuroplasticity / Neurosciences / original-article / Parahippocampal gyrus / Patient outcomes / Patients / Pharmacotherapy / Physiological aspects / Prefrontal cortex / Prefrontal Cortex - diagnostic imaging / Prefrontal Cortex - physiopathology / Psychiatric Status Rating Scales / Psychiatry / Psychotherapy / Schizophrenia / Schizophrenia - complications / Schizophrenia - therapy / Transcranial magnetic stimulation / Transcranial Magnetic Stimulation - methods / Transcranial Magnetic Stimulation - psychology / Treatment Outcome